Provider Demographics
NPI:1336176478
Name:TAX, THOMAS M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:TAX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14732 JAYSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-7410
Mailing Address - Country:US
Mailing Address - Phone:301-879-9299
Mailing Address - Fax:
Practice Address - Street 1:1500 FOREST GLEN ROAD
Practice Address - Street 2:HOLY CROSS HOSPITAL
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1484
Practice Address - Country:US
Practice Address - Phone:301-754-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC00440363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR22889Medicare UPIN
MD018549P80Medicare ID - Type Unspecified